Coronary heart disease in Swedish twins : quantitative genetic studies

To this point in time, coronary heart disease (CHD) has been a major cause of morbidity and mortality in the industrialized part of the world. During the last decades a decrease in morbidity and mortality has been observed in the developed countries. The bases for this progress are mainly improvements in the health care system, medical interventions, and changes in people's lifestyle; habits related to an increased risk of the disease, like smoking, obesity and physical inactivity. In conclusion, this progress is mainly due to environmental changes. However, other factors, not possible to modify, like genetic factors, also contribute to the burden of CHD. Thus far, it has been shown that a positive family history of CHD increases risk. In addition, a large number of candidate genes have been suggested to be associated with CHD through related mechanisms such as lipid metabolism, blood pressure regulation, and insulin sensitivity. However, it has been difficult to quantify genetic influences by summarizing risks and effects of known genes, as the number of these genes is large and the effect of each gene small. The primary aim of this thesis was, therefore, to determine the overall impact of genetic and environmental factors on CHD-death and the CHD subphenotypes acute myocardial infarction (AMI) and angina pectoris (AP). The secondary aims were to study if genetic influences change with age and to what extent they are mediated through well known risk factors and AP. Twin pairs born between 1886 and 1958 from the Swedish Twin Registry were used to calculate concordances, hazard ratios and heritability. Heritability estimates were obtained by two approaches, the frailty and the liability approach. Analyses of concordances resulted in higher concordances for CHD in monozygotic (MZ) than dizygotic (M) twins as well as in higher estimates at younger ages. 1 Heritability for CHD-death was estimated to 0.57 (95 % Cl 0.45-0.69) among males and 0.38 (0.26-0.50) among females, and extension of the follow-up time resulted in a decrease in heritability with increasing length of follow-up (paper 1). Including known risk factors (smoking, obesity, hypertension, diabetes, level of education, and marital status) into genetic analyses resulted in a slight decrease of genetic variance and thus a slight portion (among males and more so among females) of genetic variance was accounted for by the genetic variance for studied risk factors (paper 11), AP was shown to be an important risk factor for CHDdeath in both sexes, although more so in males. Heritability analyses resulted in moderate heritability estimates for AP in both sexes (0.39 (0.29-0.49) in males and 0.43 (0.08-0.5 1) in females). The correlation between AP and CHD was almost entirely explained by the influence of familial factors in both sexes (paper 111). 1 Heritability for AMI resulted also in moderate estimates, 0.35 (0.28-043) for males and 0.38 (0.290,46) for females (paper IV). In conclusion, genetic factors influence CHD-death to a moderate degree as well as the sub phenotypes AMI and AP. Genetic influences for death from CHD are slightly higher among males and more important at younger ages. Finally, genetic influences for CHD-death are slightly modified through risk factors and AP in males and more so in females

PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION : A SYSTEMATIC APPROACH

The societal effects of forced migration are a burning topic of current political debate in Europe. There is an obvious absence of sustainable approaches to deal with this issue. We describe a collaborative and systemic regional effort, involving some 50 partners, towards a health-promoting and inclusive integration process designed to reach all refugees who settle in the southern region of Sweden. The main components of this process are now being disseminated to other regions in Sweden, which is contributing to national capacity-building. In addition, a national educational programme is being developed for those engaged in conveying civic and health information to asylum seekers and refugees. This work involves stakeholders in collaboration with six universities from different geographical areas of Sweden. The effort we describe in this report is expected to greatly contribute to providing better opportunities for all refugees in Sweden, and to empower them to control their own adaptation to a new life, thus reducing the risk of health deterioration often seen among them

Crowded living and its association with mental ill-health among recently-arrived migrants in Sweden: a quantitative study

Abstract Objective Housing and neighbourhood conditions are widely acknowledged important social determinants of health and health inequalities that persist in developed countries despite general improvements in health outcomes across populations. Previous research has investigated what effect crowded living conditions have on mental health and concluded that women living in crowded conditions were more likely to suffer from depression. In contrast, men living in the same conditions responded with withdrawal or aggression. To the best of our knowledge, only a few studies have examined the association between recently-arrived migrants living in crowded conditions and poor mental health. The aim of this study was to investigate the association between crowded living conditions among recently-arrived migrants in Sweden and mental ill-health. The result is based on 681 migrants who completed and returned questionnaires in 2015–2016. Results The analyses, independent of gender, resulted in a significant unadjusted odds ratio of 1.46 (95% CI 1.05–2.03); even after adjustments were made, the association remained significant OR 1.47 (1.05–2.07). When adding stability in housing into the adjustment-model, the OR did not remain significant OR 1.40 (0.99–1.99), P-value 0.061

PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION : A SYSTEMATIC APPROACH

The societal effects of forced migration are a burning topic of current political debate in Europe. There is an obvious absence of sustainable approaches to deal with this issue. We describe a collaborative and systemic regional effort, involving some 50 partners, towards a health-promoting and inclusive integration process designed to reach all refugees who settle in the southern region of Sweden. The main components of this process are now being disseminated to other regions in Sweden, which is contributing to national capacity-building. In addition, a national educational programme is being developed for those engaged in conveying civic and health information to asylum seekers and refugees. This work involves stakeholders in collaboration with six universities from different geographical areas of Sweden. The effort we describe in this report is expected to greatly contribute to providing better opportunities for all refugees in Sweden, and to empower them to control their own adaptation to a new life, thus reducing the risk of health deterioration often seen among them

Crowded living and its association with mental ill-health among recently-arrived migrants in Sweden : a quantitative study

Objective Housing and neighbourhood conditions are widely acknowledged important social determinants of health and health inequalities that persist in developed countries despite general improvements in health outcomes across populations. Previous research has investigated what effect crowded living conditions have on mental health and concluded that women living in crowded conditions were more likely to suffer from depression. In contrast, men living in the same conditions responded with withdrawal or aggression. To the best of our knowledge, only a few studies have examined the association between recently-arrived migrants living in crowded conditions and poor mental health. The aim of this study was to investigate the association between crowded living conditions among recently-arrived migrants in Sweden and mental ill-health. The result is based on 681 migrants who completed and returned questionnaires in 2015-2016. Results The analyses, independent of gender, resulted in a significant unadjusted odds ratio of 1.46 (95% CI 1.05-2.03); even after adjustments were made, the association remained significant OR 1.47 (1.05-2.07). When adding stability in housing into the adjustment-model, the OR did not remain significant OR 1.40 (0.99-1.99), p-value 0.061

Kvantitativa studier bland nyanlända ungdomar och ensamkommande : Tillvägagångssätt och utmaningar

Det finns ett flertal tillfällen då det är svårt att hitta respondenter via traditionella register eller insamlingsmetoder. Att undersöka nyanlända ungdomars hälsa är ett sådant tillfälle. Projektet MILSA 2.0 är en forskningsbaserad stöd- och utvecklingsplattform och ett av projektets mål har varit att utveckla metoder för att samla in kunskap om nyanländas hälsa. I delprojektet MILSA 2.3 undersöks barn och ungdomars hälsosituation framförallt med fokus på social kapital, riskbeteenden och framtidstro. Den metod som utvecklades i projektet byggde på att samla in enkätsvar via skolorna i Skånes kommuner. Metoden förutsatte ett nära samarbete med kontaktpersoner i kommunerna. Enkäterna var översatta av MILSA-projektet till arabiska, dari och pashto, men även en version på svenska erbjöds respondenterna. Trots vissa brister utifrån ett traditionellt obundet slumpmässigt urval (OSU), menar vi att urvalet kan svara på frågor som vi inte annars hade kunnat få svar på. Vi bör naturligtvis vara medvetna om de brister som finns i urvalet, men samtidigt kan det bidra till ny kunskap om en grupp där det finns väldigt begränsat med data. För framtida studier av liknande grupper bör mer resurser avsättas för ett närmare samarbete med kommunerna och studien måste tydligare förankras med skolor och kommuner utifrån den metod som ska användas.Working paper</p

Kvantitativa studier bland nyanlända ungdomar och ensamkommande : Tillvägagångssätt och utmaningar

Det finns ett flertal tillfällen då det är svårt att hitta respondenter via traditionella register eller insamlingsmetoder. Att undersöka nyanlända ungdomars hälsa är ett sådant tillfälle. Projektet MILSA 2.0 är en forskningsbaserad stöd- och utvecklingsplattform och ett av projektets mål har varit att utveckla metoder för att samla in kunskap om nyanländas hälsa. I delprojektet MILSA 2.3 undersöks barn och ungdomars hälsosituation framförallt med fokus på social kapital, riskbeteenden och framtidstro. Den metod som utvecklades i projektet byggde på att samla in enkätsvar via skolorna i Skånes kommuner. Metoden förutsatte ett nära samarbete med kontaktpersoner i kommunerna. Enkäterna var översatta av MILSA-projektet till arabiska, dari och pashto, men även en version på svenska erbjöds respondenterna. Trots vissa brister utifrån ett traditionellt obundet slumpmässigt urval (OSU), menar vi att urvalet kan svara på frågor som vi inte annars hade kunnat få svar på. Vi bör naturligtvis vara medvetna om de brister som finns i urvalet, men samtidigt kan det bidra till ny kunskap om en grupp där det finns väldigt begränsat med data. För framtida studier av liknande grupper bör mer resurser avsättas för ett närmare samarbete med kommunerna och studien måste tydligare förankras med skolor och kommuner utifrån den metod som ska användas.Working paper</p

Kvantitativa studier bland nyanlända ungdomar och ensamkommande : Tillvägagångssätt och utmaningar

Det finns ett flertal tillfällen då det är svårt att hitta respondenter via traditionella register eller insamlingsmetoder. Att undersöka nyanlända ungdomars hälsa är ett sådant tillfälle. Projektet MILSA 2.0 är en forskningsbaserad stöd- och utvecklingsplattform och ett av projektets mål har varit att utveckla metoder för att samla in kunskap om nyanländas hälsa. I delprojektet MILSA 2.3 undersöks barn och ungdomars hälsosituation framförallt med fokus på social kapital, riskbeteenden och framtidstro. Den metod som utvecklades i projektet byggde på att samla in enkätsvar via skolorna i Skånes kommuner. Metoden förutsatte ett nära samarbete med kontaktpersoner i kommunerna. Enkäterna var översatta av MILSA-projektet till arabiska, dari och pashto, men även en version på svenska erbjöds respondenterna. Trots vissa brister utifrån ett traditionellt obundet slumpmässigt urval (OSU), menar vi att urvalet kan svara på frågor som vi inte annars hade kunnat få svar på. Vi bör naturligtvis vara medvetna om de brister som finns i urvalet, men samtidigt kan det bidra till ny kunskap om en grupp där det finns väldigt begränsat med data. För framtida studier av liknande grupper bör mer resurser avsättas för ett närmare samarbete med kommunerna och studien måste tydligare förankras med skolor och kommuner utifrån den metod som ska användas